# A quality improvement project on reimaging for provision of extended window mechanical thrombectomy when 24/7 service is not available

## TL;DR

This study shows how patients without access to 24/7 stroke treatment can still receive mechanical thrombectomy through early morning rescanning.

## Contribution

A new protocol was developed to extend mechanical thrombectomy access during non-operating hours in stroke centers.

## Key findings

- 22 out of 39 patients in the project received mechanical thrombectomy after the protocol was implemented.
- Rescanning patients before service opening identified eligible candidates for treatment.
- The protocol allows access to MT for LVO stroke patients in non-operating hours.

## Abstract

Mechanical thrombectomy (MT) has revolutionised the treatment of ischaemic stroke, leading to decreased rates of disability and mortality. However, many centres are unable to deliver a 24/7 service. Consequently, many patients who present in the non-operating hours are not considered for this treatment.

We conducted a quality improvement project (QIP) to provide patients presenting out of hours with access to MT. To achieve this, we designed a protocol to rescan those patients just before opening of the service to select the candidates based on the favourable perfusion criteria.

Twenty-two out of the 39 patients included in the QIP had MT, which was not accessible before initiation of our protocol.

In stroke centres where 24/7 MT service is not available, patients with large vessel occlusion (LVO) stroke, who present in the non-operating hours, can get access to this treatment by consideration of early morning rescanning just before opening of the service.